Provider Demographics
NPI:1831305853
Name:HAGERMAN, BROOKE E
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:E
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S WATER ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1332
Mailing Address - Country:US
Mailing Address - Phone:217-423-6199
Mailing Address - Fax:217-423-1035
Practice Address - Street 1:132 S WATER ST
Practice Address - Street 2:SUITE 604
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1332
Practice Address - Country:US
Practice Address - Phone:217-423-6199
Practice Address - Fax:217-423-1035
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor